Goal 1 improve the accuracy of patient identification.nps

Goal 1
Improve the accuracy of patient identification.
NPSG.01.01.01
Use at least two patient identifiers when providing care,
treatment, and services.
--Rationale for NPSG.01.01.01--
Wrong-patient errors occur in virtually all stages of diagnosis
and treatment. The intent for this goal is two-
fold: first, to reliably identify the individual as the person for
whom the service or treatment is intended;
second, to match the service or treatment to that individual.
Acceptable identifiers may be the individual’s
name, an assigned identification number, telephone number, or
other person-specific identifier.
Newborns are at higher risk of misidentification due to their
inability to speak and lack of distinguishable
features. In addition to well-known misidentification errors
such as wrong patient/wrong procedure,
misidentification has also resulted in feeding a mother’s
expressed breastmilk to the wrong newborn, which
poses a risk of passing bodily fluids and potential pathogens to
the newborn. A reliable identification system
among all providers is necessary to prevent errors.
Element(s) of Performance for NPSG.01.01.01
1. Use at least two patient identifiers when administering

medications, blood, or blood components; when
collecting blood samples and other specimens for clinical
testing; and when providing treatments or
procedures. The patient's room number or physical location is
not used as an identifier.
(See also MM.05.01.09, EPs 7, 10; PC.02.01.01, EP 10)
2. Label containers used for blood and other specimens in the
presence of the patient.
(See also PC.02.01.01, EP 10)
3. Use distinct methods of identification for newborn patients.
Note: Examples of methods to prevent misidentification may
include the following:
- Distinct naming systems could include using the mother’s first
and last names and the newborn’s
gender (for example, “Smith, Judy Girl” or “Smith, Judy Girl
A” and “Smith, Judy Girl B” for multiples).
- Standardized practices for identification banding (for example,
using two body sites and/or bar coding
for identification).
- Establish communication tools among staff (for example,
visually alerting staff with signage noting
newborns with similar names).
© 2020 The Joint Commission
Page 1 of 14
Report Generated by DSSM
Wednesday, Oct 28 2020
National Patient Safety Goals Effective
January 2021 for the Hospital Program

Goal 2
Improve the effectiveness of communication among caregivers.
NPSG.02.03.01
Report critical results of tests and diagnostic procedures on a
timely basis.
Critical results of tests and diagnostic procedures fall
significantly outside the normal range and may indicate
a life-threatening situation. The objective is to provide the
responsible licensed caregiver these results within
an established time frame so that the patient can be promptly
treated.
1. Develop written procedures for managing the critical results
of tests and diagnostic procedures that
address the following:
- The definition of critical results of tests and diagnostic
procedures
- By whom and to whom critical results of tests and diagnostic
procedures are reported
- The acceptable length of time between the availability and
reporting of critical results of tests and
diagnostic procedures
2. Implement the procedures for managing the critical results of
tests and diagnostic procedures.
3. Evaluate the timeliness of reporting the critical results of
tests and diagnostic procedures.

Goal 3
Improve the safety of using medications.
NPSG.03.04.01
Label all medications, medication containers, and other
solutions on and off the sterile field in perioperative and other
procedural settings.
Note: Medication containers include syringes, medicine cups,
and basins.
Medications or other solutions in unlabeled containers are
unidentifiable. Errors, sometimes tragic, have
resulted from medications and other solutions removed from
their original containers and placed into
unlabeled containers. This unsafe practice neglects basic
principles of safe medication management, yet it is
routine in many organizations.
The labeling of all medications, medication containers, and
other solutions is a risk-reduction activity
consistent with safe medication management. This practice
addresses a recognized risk point in the
administration of medications in perioperative and other
procedural settings. Labels for medications and
medication containers are also addressed at Standard
MM.05.01.09.
1. In perioperative and other procedural settings both on and off
the sterile field, label medications and
solutions that are not immediately administered. This applies
even if there is only one medication

being used.
Note: An immediately administered medication is one that an
authorized staff member prepares or
obtains, takes directly to a patient, and administers to that
patient without any break in the process.
Refer to NPSG.03.04.01, EP 5, for information on timing of
labeling.
Page 2 of 14
the sterile field, labeling occurs when
any medication or solution is transferred from the original
packaging to another container.
the sterile field, medication or solution
labels include the following:
- Medication or solution name
- Strength
- Amount of medication or solution containing medication (if
not apparent from the container)
- Diluent name and volume (if not apparent from the container)
- Expiration date when not used within 24 hours
- Expiration time when expiration occurs in less than 24 hours
Note: The date and time are not necessary for short procedures,
as defined by the hospital.

4. Verify all medication or solution labels both verbally and
visually. Verification is done by two individuals
qualified to participate in the procedure whenever the person
preparing the medication or solution is
not the person who will be administering it.
5. Label each medication or solution as soon as it is prepared,
unless it is immediately administered.
Note: An immediately administered medication is one that an
authorized staff member prepares or
obtains, takes directly to a patient, and administers to that
patient without any break in the process.
6. Immediately discard any medication or solution found
unlabeled.
7. Remove all labeled containers on the sterile field and discard
their contents at the conclusion of the
procedure.
Note: This does not apply to multiuse vials that are handled
according to infection control practices.
8. All medications and solutions both on and off the sterile field
and their labels are reviewed by entering
and exiting staff responsible for the management of
medications.
NPSG.03.05.01
Reduce the likelihood of patient harm associated with the use of
anticoagulant therapy.
Note: This requirement does not apply to routine situations in
which short-term prophylactic anticoagulation is used for
preventing venous thromboembolism (for example, related to
procedures or hospitalization).

Anticoagulation therapy can be used as therapeutic treatment
for several conditions, the most common of
which are atrial fibrillation, deep vein thrombosis, pulmonary
embolism, and mechanical heart valve implant.
However, it is important to note that anticoagulant medications
are more likely than others to cause harm due
to complex dosing, insufficient monitoring, and inconsistent
patient compliance. This National Patient Safety
Goal has great potential to positively impact the safety of
patients on this class of medications, including
improving patient outcomes.
To achieve better patient outcomes, patient education is a vital
component of an anticoagulation therapy
program. Effective anticoagulation education includes face-to-
face interaction with a trained professional who
works closely with patients to be sure that they understand the
risks involved with anticoagulation therapy
and the precautions they need to take. The use of standardized
practices for anticoagulation therapy that
include patient involvement can reduce the risk of adverse drug
events associated with heparin
(unfractionated), low molecular weight heparin, warfarin, and
direct oral anticoagulants (DOACs).
1. The hospital uses approved protocols and evidence-based
practice guidelines for the initiation and
maintenance of anticoagulant therapy that address medication
selection; dosing, including
adjustments for age and renal or liver function; drug–drug and
drug–food interactions; and other risk

factors as applicable.
Page 3 of 14
practice guidelines for reversal of
anticoagulation and management of bleeding events related to
each anticoagulant medication.
practice guidelines for perioperative
management of all patients on oral anticoagulants.
Note: Perioperative management may address the use of
bridging medications, timing for stopping an
anticoagulant, and timing and dosing for restarting an
anticoagulant.
4. The hospital has a written policy addressing the need for
baseline and ongoing laboratory tests to
monitor and adjust anticoagulant therapy.
Note: For all patients receiving warfarin therapy, use a current
international normalized ratio (INR) to
monitor and adjust dosage. For patients on a direct oral
anticoagulant (DOAC), follow evidence-based
practice guidelines regarding the need for laboratory testing.
5. The hospital addresses anticoagulation safety practices

through the following:
- Establishing a process to identify, respond to, and report
adverse drug events, including adverse
drug event outcomes
- Evaluating anticoagulation safety practices, taking actions to
improve safety practices, and
measuring the effectiveness of those actions in a time frame
determined by the hospital
6. The hospital provides education to patients and families
specific to the anticoagulant medication
prescribed, including the following:
- Adherence to medication dose and schedule
- Importance of follow-up appointments and laboratory testing
(if applicable)
- Potential drug–drug and drug–food interactions
- The potential for adverse drug reactions
7. The hospital uses only oral unit-dose products, prefilled
syringes, or premixed infusion bags when
these types of products are available.
Note: For pediatric patients, prefilled syringe products should
be used only if specifically designed for
children.
8. When heparin is administered intravenously and
continuously, the hospital uses programmable pumps
in order to provide consistent and accurate dosing.
Page 4 of 14

Introduction to Reconciling Medication Information
The large number of people receiving health care who take
multiple medications and the
complexity of managing those medications make medication
reconciliation an important safety
issue. In medication reconciliation, a clinician compares the
medications a patient should be using
(and is actually using) to the new medications that are ordered
for the patient and resolves any
discrepancies.
The Joint Commission recognizes that organizations face
challenges with medication reconciliation.
The best medication reconciliation requires a complete
understanding of what the patient was
prescribed and what medications the patient is actually taking.
It can be difficult to obtain a
complete list from every patient in an encounter, and accuracy
is dependent on the patient’s ability
and willingness to provide this information. A good faith effort
to collect this information is
recognized as meeting the intent of the requirement. As health
care evolves with the adoption of
more sophisticated systems (such as centralized databases for
prescribing and collecting
medication information), the effectiveness of these processes
will grow.
This National Patient Safety Goal (NPSG) focuses on the risk
points of medication reconciliation.
The elements of performance in this NPSG are designed to help
organizations reduce negative

patient outcomes associated with medication discrepancies.
Some aspects of the care process that
involve the management of medications are addressed in the
standards rather than in this goal.
These include coordinating information during transitions in
care both within and outside of the
organization (PC.02.02.01), patient education on safe
medication use (PC.02.03.01), and
communications with other providers (PC.04.02.01).
In settings where medications are not routinely prescribed or
administered, this NPSG provides
organizations with the flexibility to decide what medication
information they need to collect based
on the services they provide to patients. It is often important for
clinicians to know what medications
the patient is taking when planning care, treatment, and
services, even in situations where
medications are not used.
NPSG.03.06.01
Maintain and communicate accurate patient medication
information.
There is evidence that medication discrepancies can affect
patient outcomes. Medication reconciliation is
intended to identify and resolve discrepancies—it is a process
of comparing the medications a patient is
taking (or should be taking) with newly ordered medications.
The comparison addresses duplications,
omissions, and interactions, and the need to continue current
medications. The types of information that
clinicians use to reconcile medications include (among others)

medication name, dose, frequency, route, and
purpose. Organizations should identify the information that
needs to be collected in order to reconcile current
and newly ordered medications and to safely prescribe
medications in the future.
1. Obtain information on the medications the patient is currently
taking when he or she is admitted to the
hospital or is seen in an outpatient setting. This information is
documented in a list or other format that
is useful to those who manage medications.
Note 1: Current medications include those taken at scheduled
times and those taken on an as-needed
basis. See the Glossary for a definition of medications.
Note 2: It is often difficult to obtain complete information on
current medications from a patient. A good
faith effort to obtain this information from the patient and/or
other sources will be considered as
meeting the intent of the EP.
Page 5 of 14
2. Define the types of medication information (for example,
name, dose, route, frequency, purpose) to be
collected in non-24-hour settings.

Note: Examples of non-24-hour settings include the emergency
department, primary care, outpatient
radiology, ambulatory surgery, and diagnostic settings.
3. Compare the medication information the patient brought to
the hospital with the medications ordered
for the patient by the hospital in order to identify and resolve
discrepancies.
Note: Discrepancies include omissions, duplications,
contraindications, unclear information, and
changes. A qualified individual, identified by the hospital, does
the comparison. (See also
HR.01.06.01, EP 1)
4. Provide the patient (or family, caregiver, or support person as
needed) with written information on the
medications the patient should be taking when he or she is
discharged from the hospital or at the end
of an outpatient encounter (for example, name, dose, route,
frequency, purpose).
5. Explain the importance of managing medication information
to the patient when he or she is
discharged from the hospital or at the end of an outpatient
encounter.
Note: Examples include instructing the patient to give a list to
his or her primary care physician; to
update the information when medications are discontinued,
doses are changed, or new medications
(including over-the-counter products) are added; and to carry
medication information at all times in the
event of emergency situations. (For information on patient
education on medications, refer to
Standards MM.06.01.03, PC.02.03.01, and PC.04.01.05.)

of 14
Goal 6
Reduce patient harm associated with clinical alarm systems.
NPSG.06.01.01
Improve the safety of clinical alarm systems.
Clinical alarm systems are intended to alert caregivers of
potential patient problems, but if they are not
properly managed, they can compromise patient safety. This is a
multifaceted problem. In some situations,
individual alarm signals are difficult to detect. At the same
time, many patient care areas have numerous
alarm signals and the resulting noise and displayed information
tends to desensitize staff and cause them to
miss or ignore alarm signals or even disable them. Other issues
associated with effective clinical alarm
system management include too many devices with alarms,
default settings that are not at an actionable
level, and alarm limits that are too narrow. These issues vary
greatly among hospitals and even within
different units in a single hospital.
There is general agreement that this is an important safety issue.

Universal solutions have yet to be
identified, but it is important for a hospital to understand its
own situation and to develop a systematic,
coordinated approach to clinical alarm system management.
Standardization contributes to safe alarm
system management, but it is recognized that solutions may
have to be customized for specific clinical units,
groups of patients, or individual patients. This NPSG focuses on
managing clinical alarm systems that have
the most direct relationship to patient safety.
Note: Additional information on alarm safety can be found on
the AAMI website
https://www.aamifoundation.org/coalitions/clinical-alarm-
systems/complementary-research/.
1. Leaders establish alarm system safety as a hospital priority.
2. Identify the most important alarm signals to manage based on
the following:
- Input from the medical staff and clinical departments
- Risk to patients if the alarm signal is not attended to or if it
malfunctions
- Whether specific alarm signals are needed or unnecessarily
contribute to alarm noise and alarm
fatigue
- Potential for patient harm based on internal incident history
- Published best practices and guidelines
(For more information on managing medical equipment risks,
refer to Standard EC.02.04.01)
3. Establish policies and procedures for managing the alarms
identified in EP 2 above that, at a
minimum, address the following:
- Clinically appropriate settings for alarm signals

- When alarm signals can be disabled
- When alarm parameters can be changed
- Who in the organization has the authority to set alarm
parameters
- Who in the organization has the authority to change alarm
parameters
- Who in the organization has the authority to set alarm
parameters to “off”
- Monitoring and responding to alarm signals
- Checking individual alarm signals for accurate settings, proper
operation, and detectability
(For more information, refer to Standard EC.02.04.03)
4. Educate staff and licensed independent practitioners about
the purpose and proper operation of alarm
systems for which they are responsible.
Page 7 of 14
Goal 7
Reduce the risk of health care–associated infections.
NPSG.07.01.01
Comply with either the current Centers for Disease Control and
Prevention (CDC) hand hygiene guidelines and/or the
current World Health Organization (WHO) hand hygiene

guidelines.
According to the Centers for Disease Control and Prevention,
each year, millions of people acquire an
infection while receiving care, treatment, and services in a
health care organization. Consequently, health
care–associated infections (HAIs) are a patient safety issue
affecting all types of health care organizations.
One of the most important ways to address HAIs is by
improving the hand hygiene of health care staff.
Compliance with the World Health Organization (WHO) or
Centers for Disease Control and Prevention (CDC)
hand hygiene guidelines will reduce the transmission of
infectious agents by staff to patients, thereby
decreasing the incidence of HAIs. To ensure compliance with
this National Patient Safety Goal, an
organization should assess its compliance with the CDC and/or
WHO guidelines through a comprehensive
program that provides a hand hygiene policy, fosters a culture
of hand hygiene, monitors compliance, and
provides feedback.
1. Implement a program that follows categories IA, IB, and IC
of either the current Centers for Disease
Control and Prevention (CDC) or the current World Health
Organization (WHO) hand hygiene
guidelines. (See also IC.01.04.01, EP 1)
2. Set goals for improving compliance with hand hygiene
guidelines. (See also IC.03.01.01, EP 1)
3. Improve compliance with hand hygiene guidelines based on

established goals.
Page 8 of 14
NPSG.15.01.01
Reduce the risk for suicide.
Note: EPs 2–7 apply to patients in psychiatric hospitals or
patients being evaluated or treated for behavioral health
conditions as their primary reason for care. In addition, EPs 3–7
apply to all patients who express suicidal ideation
during the course of care.
Suicide of a patient while in a staffed, round-the-clock care
setting is a frequently reported type of sentinel
event. Identification of individuals at risk for suicide while
under the care of or following discharge from a
health care organization is an important step in protecting these
at-risk individuals.
1. For psychiatric hospitals and psychiatric units in general
hospitals: The hospital conducts an
environmental risk assessment that identifies features in the

physical environment that could be used
to attempt suicide; the hospital takes necessary action to
minimize the risk(s) (for example, removal of
anchor points, door hinges, and hooks that can be used for
hanging).
For nonpsychiatric units in general hospitals: The organization
implements procedures to mitigate the
risk of suicide for patients at high risk for suicide, such as one-
to-one monitoring, removing objects that
pose a risk for self-harm if they can be removed without
adversely affecting the patient’s medical care,
assessing objects brought into a room by visitors, and usi ng safe
transportation procedures when
moving patients to other parts of the hospital.
Note: Nonpsychiatric units in general hospitals do not need to
be ligature resistant. Nevertheless,
these facilities should routinely assess clinical areas to identify
objects that could be used for self-harm
and remove those objects, when possible, from the area around a
patient who has been identified as
high risk for suicide. This information can be used for training
staff who monitor high-risk patients (for
example, developing checklists to help staff remember which
equipment should be removed when
possible).
2. Screen all patients for suicidal ideation who are being
evaluated or treated for behavioral health
conditions as their primary reason for care using a validated
screening tool.
Note: The Joint Commission requires screening for suicidal
ideation using a validated tool starting at
age 12 and above.
3. Use an evidence-based process to conduct a suicide

assessment of patients who have screened
positive for suicidal ideation. The assessment directly asks
about suicidal ideation, plan, intent, suicidal
or self-harm behaviors, risk factors, and protective factors.
Note: EPs 2 and 3 can be satisfied through the use of a single
process or instrument that
simultaneously screens patients for suicidal ideation and
assesses the severity of suicidal ideation.
4. Document patients’ overall level of risk for suicide and the
plan to mitigate the risk for suicide.
5. Follow written policies and procedures addressing the care of
patients identified as at risk for suicide.
At a minimum, these should include the following:
- Training and competence assessment of staff who care for
patients at risk for suicide
- Guidelines for reassessment
- Monitoring patients who are at high risk for suicide
6. Follow written policies and procedures for counseling and
follow-up care at discharge for patients
identified as at risk for suicide.
7. Monitor implementation and effectiveness of policies and
procedures for screening, assessment, and
management of patients at risk for suicide and take action as
needed to improve compliance.
Page 9 of 14

The hospital identifies safety risks inherent in its patient
population.
Goal 15
Introduction to the Universal Protocol for Preventing Wrong
Site, Wrong
Procedure, and Wrong Person Surgery™
The Universal Protocol applies to all surgical and nonsurgical
invasive procedures. Evidence indicates that
procedures that place the patient at the most risk include those
that involve general anesthesia or deep
sedation, although other procedures may also affect patient
safety. Hospitals can enhance safety by correctly
identifying the patient, the appropriate procedure, and the
correct site of the procedure.
The Universal Protocol is based on the following principles:
- Wrong-person, wrong-site, and wrong-procedure surgery can
and must be prevented.
- A robust approach using multiple, complementary strategies is
necessary to achieve the goal of always
conducting the correct procedure on the correct person, at the
correct site.
- Active involvement and use of effective methods to improve
communication among all members of the
procedure team are important for success.
- To the extent possible, the patient and, as needed, the family
are involved in the process.
- Consistent implementation of a standardized protocol is most
effective in achieving safety.

The Universal Protocol is implemented most successfully in
hospitals with a culture that promotes teamwork
and where all individuals feel empowered to protect patient
safety. A hospital should consider its culture
when designing processes to meet the Universal Protocol. In
some hospitals, it may be necessary to be
more prescriptive on certain elements of the Universal Protocol
or to create processes that are not
specifically addressed within these requirements.
Hospitals should identify the timing and location of the
preprocedure verification and site marking based on
what works best for their own unique circumstances. The
frequency and scope of the preprocedure
verification will depend on the type and complexity of the
procedure. The three components of the Universal
Protocol are not necessarily presented in chronological order
(although the preprocedure verification and site
marking precede the final verification in the time-out).
Preprocedure verification, site marking, and the time-
out procedures should be as consistent as possible throughout
the hospital.
Note: Site marking is not required when the individual doing
the procedure is continuously with the patient
from the time of the decision to do the procedure through to the
performance of the procedure.
Page 10 of 14

UP.01.01.01
Conduct a preprocedure verification process.
--Rationale for UP.01.01.01--
Hospitals should always make sure that any procedure is what
the patient needs and is performed on the
right person. The frequency and scope of the verification
process will depend on the type and complexity of
the procedure.
The preprocedure verification is an ongoing process of
information gathering and confirmation. The purpose
of the preprocedure verification process is to make sure that all
relevant documents and related information
or equipment are as follows:
- Available prior to the start of the procedure
- Correctly identified, labeled, and matched to the patient’s
identifiers
- Reviewed and are consistent with the patient’s expectations
and with the team’s understanding of the
intended patient, procedure, and site
Preprocedure verification may occur at more than one …
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References
Rainie, L., & Wellman, B. (2012). Future of the networked.
New Scientist, 215(2875), 24–25.
https://doi.org/10.1016/S0262-4079(12)61936-8

Future of the networked
OPINION
An always-on world is rapidly reshaping human social
interactions. Expect a battle between freedom and control, say
Lee Rainie and Barry Wellman
OUR social relationships are changing and technology is at the
centre of this unfolding story.
Take stock of your own world. You probably have a few family

members and friends who mean the world to you. Then there are
the many acquaintances, contacts, "followers" and
"consequential strangers" who you only interact with
occasionally but who serve useful purposes when you have
questions, need to make decisions or require a helping hand.
Your ties to all of them, especially those in the outer reaches of
your network, are increasingly mediated through digital
technology -- from email to Facebook to Skype calls.
This new social operating system has been emerging for several
generations but has accelerated in growth thanks to the recent
triple revolution: the widespread adoption of broadband,
ubiquitous mobile connectivity and the move from bounded
groups -- largely closed circles of interlinked contacts -- to
multiple social networks.
We have dubbed the result networked individualism because
loose-knit networks are overtaking more densely knit groups
and traditional hierarchies as the dominant structure of social
interaction.
In the world of networked individuals, the individual is the
focus, not the family, the work unit, the neighbourhood or the
social group. Each person creates their own network tailored to
their needs, maintaining it through their email address and
address book, screen name, social and technological filters, and
cellphone number.
Networks are thriving. People have more strong ties as well as
weak ones. The number of people on the periphery of each
network is growing. In this Web 2.0 world, community-building
can take new forms. Hobbyists, the civic minded, caregivers,
spiritual pathfinders and many others have the option of
plugging into existing communities or building their own --
which they often do.
This revolution doesn't mean physical isolation, as some fear.
People still value neighbours, because they remain important for
everyday socialising and emergencies. Yet neighbours are only
about 10 per cent of our significant ties. While people see co-
workers and neighbours often, the most important contacts tend

to be with people who live elsewhere in the city, region, nation
-- and abroad.
The new media are able to facilitate such contact, and, in effect,
have become the neighbourhood. And it is heavily populated.
Data from the Pew Research Center's Internet & American Life
Project suggests that more than two-thirds of American adults
and three-quarters of teenagers have become online content
creators through social media and rankings, ratings,
commenting and remixing applications. In this world, people
can easily locate and connect with others who share their tastes,
lifestyles, politics, spiritual practices, ailments or professional
aspirations.
With such a fundamental social shift linked to still-developing
technology, how it unfolds needs to be considered. We think
there are two possible scenarios.
In the first, virtual assistants operating in a semantic web-one in
which machines can better assess the ocean of information --
seamlessly mesh a user's life logistics and interests, allowing
people to be more productive and more effective at integrating
their needs. The merger of data and the physical environment,
especially in augmented reality apps, enriches people's
experiences as they can summon information about the things
they are observing -- a landscape, buildings in an unfamiliar
city or even faces of those they encounter.
In this benign world, the challenges of information overload are
reduced as these smart agents perform filtering and relevance
tests. This lets people interact with their social networks and
growing information stores in productive and socially beneficial
ways.
In the second scenario, a walled online world of tight corporate
permissions and Big Brotherish surveillance by business and the
state limits networked life. Personal agents turn out to be
double agents, feeding back information on users that can be
sold. People are limited in what they can do with their media
and networks by those determined to prevent pirating of
content.

Moreover, tech firms and their advertising allies scan users'
behaviour for commercial exploitation. People's social network
practices are quarantined inside filter bubbles that assume they
want homogenised content and contact with like-minded
individuals, rather than a diversified, broad outreach.
Which will unfold? The future will likely include parts of each.
The architecture of the internet -- dominated by the hacker
ethic-will facilitate open networks and all the social connection
that goes with them. Legal struggles over content ownership and
the cost of access may lead to restrictions that could limit the
capacity for users to do what they want.
Evolving social norms will push both ways. Some will
encourage openness as people want to connect; others will
encourage limits as the hassled and hard-pressed withdraw
occasionally.
In short, the world will fragment, with some parts moving
towards the brighter side of networked individualism and other
parts moving towards gated communities and more tightly
controlled information flows.
The triple revolution has given rise to far-reaching
consequences, though it is not yet clear what the outermost
points of impact will be. What is evident is that networked
individualism is tightly tied to technological changes on the
horizon and that the time is ripe to contemplate the shape of
things to come.
~~~~~~~~
By Lee Rainie and Barry Wellman
Lee Rainie directs the Pew Research Center's Internet&
American Life Project based in Washington DC. Barry Wellman
is a professor of sociology and director of NetLab at the
University of Toronto, Canada. Their new book, Networked, is
out now (MIT Press)
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Encyclopedia of Communication Theory
Computer-Mediated Communication
Contributors: Author:David Holmes
Edited by: Stephen W. Littlejohn & Karen A. Foss
Book Title: Encyclopedia of Communication Theory
Chapter Title: "Computer-Mediated Communication"
Pub. Date: 2009
Access Date: February 23, 2021
Publishing Company: SAGE Publications, Inc.
City: Thousand Oaks
Print ISBN: 9781412959377
Online ISBN: 9781412959384
DOI: http://dx.doi.org/10.4135/9781412959384. n64
Print pages: 162-164

© 2009 SAGE Publications, Inc. All Rights Reserved.
This PDF has been generated from SAGE Knowledge. Please
note that the pagination of the online
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In the broadest sense, computer-mediated communication
(CMC) can be any form of communication that is
mediated by digital technology. Thus, a telephone conversation
can be said to be computer mediated if each
speech act is converted into digital code, transmitted, and then
decoded for the listener.
In relation to the speech acts themselves, such a conversation is
no different from that mediated by an
analogue or human-operated telephone exchange. However,
when the conversation is converted into a
form that is managed by computing systems, the spatial,
temporal, and social contexts of telephony can
be radically transformed. Speech acts can be digitally recorded
and digitally recognized in ways that are
storable and exchangeable with other digital information. Calls
can be screened, forwarded, and blocked, and
conversations can be timed in ways that are linked to billing; all
these properties impact how people use the
telephone, whether they use it at all, and how long they use it.
While CMC can take in the study of telephony and interactivity
in any computer-mediated form, the most
common meaning of it is related to the direct use of personal

computers for communication, to the point
that today, CMC is often used interchangeably with online
Internet communication. Thus e-mail, chat rooms,
bulletin boards, and simulated worlds are all forms of CMC. But
the distinguishing feature here is that what
is being mediated is communication—not information or
entertainment. Browsing the World Wide Web and
downloading information—the primary activity of Web 1.0 (the
original use of the Internet)—are not examples
of CMC. Rather, communication between individuals, whether
one-to-one or many-to-many, sharing text,
sounds, and images in Web 2.0, and interacting in next-
generation environments are examples. However,
the most common forms of CMC are e-mail, with its very low
bandwidth, or the broader-banded online social
networking outlets, in which users can post images or music.
But in each case, text predominates.
A further division here is between synchronous and
asynchronous CMC. Many chat sites, such as the early
Internet Relay Chat and “I seek you,” Multi-User Dungeons
(MUDs) and MUDs object oriented (MOOs), and
today's Second Life are in real time. The bulk of CMC,
however, is asynchronous, with e-mail and online
social networking offering the convenience of communication
that can be stored in a threaded conversation.
The fact that there are several varieties of CMC, according to
temporal and bandwidth qualities, has led some
researchers to problematize the status and nature of interactivity
in CMC.
Interactivity
Founder of the Journal of Computer-Mediated Communication,
Sheizaf Rafaeli is a key theorist who can

assist in understanding interaction within CMC. In an important
1988 article, Rafaeli distinguishes between
connectivity, reactivity, and interactivity. Networks must have a
human interface, but they must also have an
architecture that makes interactivity possible. Such interactive
networks, once established, take on a history
of their own, and through such a history, relationships are
formed. Two-way communication does not, in
itself, guarantee interactivity. Rather, an exchange or action-
reaction must develop into a relationship in which
one utterance becomes a context for another. Without this form
of connectivity, relationships become either
circular or solipsistic.
Rafaeli also wants to abandon the dyadic model that is applied
to most CMC. Online interactivity is distributed
across a network and cannot be reduced to the sum of a point-
to-point exchange. Every message takes
into account preceding messages, as well as the ways in which
previous messages react to one another.
This view of interactivity suggests that the actual use of CMC is
seldom interactive, particularly in cases of
anonymity in CMC discussion groups. For this reason, a
fundamental distinction needs to be made between
CMC users and groups that have other outside relationships and
those that do not.
Computer-Mediated Communication Research Directions
This distinction corresponds to two dominant directions in CMC
research—the cues-filter ed-out approach,
which focuses research on users, and avatar research. When
CMC is experienced as an extension of
interpersonal or institutional relationships online, interlocutors
are generally referred to as users. When

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© 2009 by SAGE Publications, Inc.
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interlocutors have no off-line relationship and identities exist
only online, they are referred to as avatars.
Cues-Filtered-Out Approach
Research into users is distinctively concerned with the way
computer-extended communication mediates
face-to-face forms of communication. The face-to-face becomes
an analogue and benchmark for measuring
the “success” of CMC, which is viewed as substituting for the
face-to-face. It is known as a cues-filtered-out
approach because it examines which cues of nonverbal
communication are missing in the communication
event and how they are put “back in.” Particularly important to
this perspective, then, is the study of emoticons,
the symbols used in e-mail to denote facial expressions, and
netiquette, the ways that cyberspace demands
the forms of polite protocol expected in embodied life.
Nancy Baym argues that in computer-mediated interaction,
people are not able to see, hear, or feel one
another, which eliminates their ability to use context cues. This
leaves them in a kind of social vacuum that is
different from face-to-face talk. Because of this, CMC
participants typically find ways of “putting back in” the
cues that are lost from external contexts. Therefore, much effort

goes into bringing these external contexts
into the content of interaction.
Baym also identifies five different sources of impact on CMC:
(1) external contexts, in which the use of
CMC is set (language, city); (2) the temporal structure of the
group (synchronistic or asynchronistic); (3)
the infrastructure of the computer system (speed, number of
computers, capacity for anonymity, user-
friendliness); (4) the purposes for which the CMC is used
(interest oriented, uses and gratifications); and (5)
the characteristics of the group and its members (group size,
educational level of participants).
Avatar Research
The second direction of CMC research—avatar research—which
was very popular in the late 1990s,
champions the exclusion of external contexts of CMC. This
research argues that online identities, or avatars,
enjoy a neutral space of interaction. Because there are no cues
that can spontaneously signify an
interlocutor's appearance, gender, class, and ethnicity, avatars
are seen to communicate on an equal footing,
without any of the social discrimination that accompanies the
above categories. An avatar can exist in a
number of CMC environments. The avatar's identity may be
limited to textual representation, or in the case of
many synchronous forms of simulated CMC—such as MUDs,
MOOs, and Second Life—an avatar can take
on a visual form and adopt voices and behavior that are
constructed online. The avatar does not have an
identity or a history other than what is formed online.
In the 1990s, the question of online identity represented by the
avatar was a major source of fascination for

CMC scholars. Social-psychological and psychoanalytic
frameworks have been used to understand virtual
identity as a unique form of self-identity without the social
inhibitions that exist in real life. The notion of
cyberpsychology emerged, and new journals, such as Cyber-
Psychology & Behavior, were established. Much
of the work in this approach sought to analyze the way CMC
relationships might deviate from real-life
relationships with respect to honesty, morality, and empathy.
Other writers, such as Sherry Turkle, saw CMC
as emancipatory because it allowed people to explore their
identity in a socially and physically safe simulated
reality.
The euphoria that characterized the social psychology of CMC
that was popular in the 1990s came under
attack from a number of writers who argued that it ignored
empirical research showing that CMC is one
medium among many by which the same people interact. The
concept of the avatar makes sense only if too
sharp a distinction is drawn between the virtual life and real
life. However, a series of everyday-life types of
empirical studies in the late 1990s showed this approach to be
unhelpful in explaining why some people spent
a great deal of time online while for others, CMC represented a
minor part of their communication practices.
Moreover, at its height, avatar research could hardly lay claim
to providing a representation of some kind of
neutral, asocial human nature when it is considered that CMC in
the mid-1990s was very much dominated by
North American upper-middle-class professionals who shared
similar interests.
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In recent years, the interest in the avatar has waned and is of
little interest to the net generation of young
people who are born as “digital natives” and have not faced the
novelty of having to migrate to digital culture.
As Susan Herring has noted, the net generation does not relate
well to the utopian speculations or the
debates about online democracy, identity, and virtuality of
earlier decades.
• avatars
• interactivity
• cues
• computer-mediated communication
• speech acts
• computers
• telephony
David Holmes
http://dx.doi.org/10.4135/9781412959384.n64
See also
• Digital Cultures
• Media Equation Theory
• Network Society
• New Media Theory
• Presence Theory
Further Readings

Baym, N.(1998).The emergence of online community. In
S.Jones (Ed.), Cybersociety: Computer-mediated
communication and community (pp. 138–163). Thousand Oaks,
CA: Sage.
Haythornthwaite, C., & Wellman, B.(2002).The Internet and
everyday life: An introduction. In B.Wellman, &
C.Haythornthwaite (Eds.), The Internet and everyday life (pp.
3–41). Malden, MA: Blackwell.
Herring, S.Slouching towards the ordinary: Current trends in
computer-mediated communication.New Media
and Society6(2004).26–
36.http://dx.doi.org/10.1177/1461444804039906
Nancy, J.-L.(1991).The Inoperative Community (ed. P.Connor;
trans. PeterConnor, LisaGarbus,
MichaelHilland, and SimonaSawhney). Minneapolis: University
of Minnesota Press.
Rafaeli, S.(1988).Interactivity: From new media to
communication. In R. P.Hawkins, J. M.Wiemann, &
S.Pingree (Eds.), Sage annual review of communication
research: Advancing communication science, Vol.
16 (pp. 10–134). Beverly Hills, CA: Sage.
Rafaeli, S., and Sudweeks, F.Networked interactivity.Journal of
Computer-Mediated
Communication2(4)(1997).Retrieved February 11, 2009, from
http://jcmc.indiana.edu/v012/issue4/
rafaeli.sudweeks.html
Riva, G., and Galimberti, C.Computer-mediated communication:
Identity and social interaction in an electronic
environment.Genetic, Social and General Psychology
Monographs124(1998).434–464.
Turkle, S.(1995).Life on the screen: Identity in the age of the
Internet.New York: Simon & Schuster.
Wellman, B., & Gulia, M.(1999).Virtual communities as
communities: Net surfers don't ride alone. In M.Smith,
& P.Kollock (Eds.), Communities in cyberspace (pp. 167–194).
London: Routledge.

Whitty, M.Liar, liar! An examination of how open, supportive
and honest people are in chat rooms.Computers
in Human Behaviour18(2002).343–
352.http://dx.doi.org/10.1016/S0747-5632%2801%2900059-0
Whitty, M., and Gavin, J.Age/sex/location: Uncovering the
social cues in the development of online
relationships.CyberPsychology and Behaviour4(2001).623 –
630.http://dx.doi.org/10.1089/
109493101753235223
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http://dx.doi.org/10.1089/109493101753235223Encyclopedia of
Communication TheoryComputer-Mediated

CommunicationInteractivityComputer-Mediated Communication
Research DirectionsCues-Filtered-Out ApproachAvatar
ResearchFurther Readings
Encyclopedia of Human Relationships
Computer-Mediated Communication
Contributors: Author:Brandon Van Der Heide & Joseph B.
Walther
Edited by: Harry T. Reis & Susan Sprecher
Book Title: Encyclopedia of Human Relationships
Chapter Title: "Computer-Mediated Communication"
Pub. Date: 2009
Access Date: February 23, 2021
Publishing Company: SAGE Publications, Inc.
City: Thousand Oaks
Print ISBN: 9781412958462
Online ISBN: 9781412958479
DOI: http://dx.doi.org/10.4135/9781412958479.n98
Print pages: 292-293
© 2009 SAGE Publications, Inc. All Rights Reserved.

This PDF has been generated from SAGE Knowledge. Please
note that the pagination of the online
version will vary from the pagination of the print book.
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Computer-mediated communication is the domain of human
communication in which individuals and groups
interact, form impressions, establish relationships, and
accomplish tasks using networked computers.
Although the timing and stylistic features of communication
often distinguish online from offline relationship
development and management, people can initiate relationships,
establish effective groups, and develop
personal partnerships using computer systems.
Generally speaking, people interacting on computers have
access to fewer nonverbal cues than those who
interact in person. Although early research predicted that people
would not be able to form meaningful
relationships using computer-mediated communication,
subsequent studies have demonstrated that
relational communication is indeed amenable to online
interaction. Because there are fewer nonverbal
cues available to people who are interacting on computers, it
typically takes longer for people to achieve
their interpersonal goals than when they interact on a face-to-
face basis. Malcolm Parks provides a useful
metaphor for understanding this aspect of computer-mediated
communication: Interpersonal interaction via
computers is a garden hose. Interpersonal information can flow

like water through the hose and fill a container
(an interpersonal impression) just as well as can a large fire
hose; it just takes longer with the smaller hose.
Since the language and timing of written messages exchanged
via computer systems convey all the social
information, with no additional matter relayed by nonverbal
behavior, it takes longer for people interacting on
computers to accrue sufficient social information with which to
form and transmit impressions and affective
influence statements.
In some cases individuals form more positive impressions of
others via computer-mediated communication
than they would form had they had a face-to-face conversation.
This phenomenon is known as hyperpersonal
communication. The nature of computer-mediated
communication contributes to the phenomenon of
hyperpersonal effects. One characteristic is that
computermediated communication allows people to carefully
select the ways that they present themselves. For example,
college students may carefully edit their grammar
when they interact with their professors on the computer so that
their professors will infer that they are
bright and conscientious. Also, because people are not located
in the same place during computer-mediated
communication and cannot observe their partners' normal
appearance and traits, people idealize their
partners' charac teristics. For example, a couple who met on an
online dating site and had their first
interactions online may overattribute the similarity and
attractiveness of their partners. Computer-mediated
communication also allows users to craft their messages quite
deliberately and edit them to fit their desired
self- and partner-oriented stereotypes and communication goals.
Computer-mediated communication is also
hypothesized to foster mutual influence of idealizing responses

so that users come to act in ways consistent
with the desires their communication partners envision of them.
Hyperpersonal communication tends to occur
quickly when people plan to have ongoing interaction with
others.
One feature that is common in some computermediated
communication settings is anonymous
communication. Anonymous communication occurs when people
communicate with one another without
knowing the specific personal identities of those with whom
they are interacting. When people are anonymous
in computer-mediated groups, they tend to be influenced by
group dynamics more strongly than they
otherwise would. Researchers believe that this occurs when
people are relating to others and thinking of
themselves as members of social groups or categories as
opposed to operating as if they were unique
individuals. This has the effect of causing people in computer -
mediated groups to exhibit behavior that is
consistent with group norms. This effect is particularly strong
when there is another group, an outgroup, which
members implicitly reject. The effect of group norms has been
used to explain the occasional occurrence of
flaming in online groups, that is, the contagious reciprocation
of insults and profanities. Early research claimed
that this kind of misbehavior was a result of the lack of
nonverbal cues in computermediated communication,
and individuals' inability to assess situational norms when they
were online. Group identification research
provides a better account of flaming, however: When it appears
in some groups, it is reciprocated and
becomes normative for that group. This is why flaming is not
endemic to all computer-mediated
communication: It is a function of local group norms
exacerbated by anonymity, and not a function of online

communication per se. Researchers continue to try to uncover
what makes people using computer-mediated
communication sometimes remain anonymous and rely on group
norms to guide their behavior, while other
times people seek and reveal unique information about
themselves and interact on a personal level.
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As new technologies develop, innovations allow people to
interact with others across multiple communication
channels. Research is beginning to focus on mixed-mode
relationships in which people interact via
computers, other media, and in person. Often this occurs when
people meet by way of the Internet and
continue their relationship through other telecommunications,
leading to face-to-face interaction. This
progression is typical when people utilize online dating Web
sites to meet and establish relationships with
potential romantic partners, but it is also common for
spontaneous friendships that develop in Internet
discussions that are not romantically oriented. An important
issue for these mixed-mode relationships is
whether people judge the information their partners present
about themselves as truthful. Indeed, some
research shows that people becoming involved in romantic
relationships seek more information about their
potential romantic partners than people who are simply friends

with one another. Current research is exploring
the characteristics of personal information about online
acquaintances which make it either more or less
believable. It appears that information is more believable when
the person it describes is unlikely to be able
to create or manipulate it.
New technologies also support mixed-mode relationships that
began offline. Social networking technologies
such as Facebook and MySpace allow friends to carry on
relationships that move between online and offline
venues. Social networking technologies also help people to stay
in touch easily with larger networks of
acquaintances. These technologies have allowed people who
were once out of touch to reconnect easily with
one another and continue their relationships online. They are a
vital tool for relational maintenance.
Brandon Van Der Heide & , and Joseph B. Walther
http://dx.doi.org/10.4135/9781412958479.n98
See also
• Communication, Instant Messaging and Other New Media
• First Impressions
• Internet, Attraction on
• Internet Dating
• Technology and Relationships
Further Readings
Lampe, C., Ellison, N., & Steinfield, C.(2007).A familiar
Face(book): Profile elements as signals in an online
social network. Proceedings of the SIGCHI Conference on
Human Factors in Computing Systems (pp.
435–444). New York: ACM
Press.http://dx.doi.org/10.1145/1240624.1240695

Lea, M., O'Shea, T., Fung, P., & Spears, R.(1992).“Flaming” in
computer-mediated communication:
Observations, explanations and implications. In M.Lea (Ed.),
Contexts of computer-mediated communication
(pp. 89–112). London: Harvester-Wheatsheaf.
Parks, M. R., and Floyd, K.Making friends in cyberspace.
Journal of Communication46(1996). 80–97.
http://dx.doi.org/10.1111/j.1460-2466.1996.tb01462.x
Walther, J. B.Computer-mediated communication: Impersonal,
interpersonal, and hyperpersonal interaction.
Communication Research23(1996). 3–43.
http://dx.doi.org/10.1177/009365096023001001
Walther, J. B., & Parks, M. R.(2002).Cues filtered out, cues
filtered in: Computer-mediated communication
and relationships. In M. L.Knapp, & J. A.Daly (Eds.),
Handbook of interpersonal communication (3rd ed. , pp.
529–563). Thousand Oaks, CA: Sage.
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http://dx.doi.org/10.1177/009365096023001001Encyclopedia of

Human RelationshipsComputer-Mediated
CommunicationFurther Readings

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